Friday, 9 December 2011

On the Albino outreach clinic and why you should lock your door whilst sleeping

I had no idea that there was such a large albino population in Tanzania nor that this group of people is both ostracised and sought after.  However they are sought after in a frightening fashion as traditional healers believe that albino body parts have mystical healing powers.  Membratu, an Ethiopian dermatology consultant working at the RDTC told me a terrifying story of an albino man waking up to find someone trying to chop off his hand!  This practice is still ongoing and will probably continue whilst such a large proportion of the population believe in the power of traditional medicine.  I was reminded of this yesterday on our ward round when we were seeing a very sick HIV positive young man who had been admitted with anaemia and widespread Kaposi sarcoma.  The medical student told us that he had stopped taking his anti-retroviral (ARVs) drugs last year and when I asked why I was told a long and involved story about a supposed priest/ healer who last year was selling a drink of holy water for 500 Tanzanian shillings (about 25p) which he claimed was a cure for everything from HIV to cancer to Diabetes and heart disease.  Apparently there were massive queues and people visiting to take the waters included government ministers as well as hopefuls from all over the country.  It seemed there was a savvy business mind behind this project as although the “healing water” was cheap as chips the refreshments were not and food cost up to £4, which is a fortune for many Tanzanians!  So half the country stopped taking their ARVs and insulin and beta blockers etc with fairly dire consequences.

The albino population is increasing mainly due to the fact that these people continue to be ostracised so tend to marry amongst themselves.  The RDTC runs a fantastic outreach programme to support the albino population.  Outreach clinics are run usually once a week and we drive to different areas in one of the two large RDTC landrovers.  For those non-medics amongst you albino patients do not have pigment in their skin, so in Africa they are at great risk of skin cancer.  It is therefore imperative that sun protective measures are begun right from birth.  Most albinos have poor eyesight and many are blind due to the lack of pigment in their eyes so the outreach programme provides sun protective clothing, wide brimmed hats and sunglasses as well as sun block for free. 

Ready for work but where are the patients?
Last Wednesday we drove to the slopes of Kilimanjaro and it was truly wonderful to be out of the KCMC compound, as without a car I had begun to go stir crazy!  The drive was beautiful through rolling hills where the land became greener and greener after the recent rains.  We stopped at a dusty clinic and all  8 of us piled out of the landrover – our driver, 2 doctors, 3 diploma students, 1 nurse and Peter who is albino and runs the excellent education campaign.  Then we sat down in true African style and waited and waited and watched the other comings and goings at the clinic and waited some more.  After about 20 minutes walking through a cloud of dust came a solitary albino man.  It seems that after the short rains is a fertile time to be working in the fields.  As albinos continue to be discriminated against many farm as their livelihood so it seems that coming to an outreach clinic is not a priority.  This single patient therefore received a full MOT and we examined him from top to toe and found several skin cancers, treated large areas of sun damage with liquid nitrogen and tried to advise him further regarding sun protection as he had obviously been wearing short sleeves, an inadequate hat and had lost his sunglasses. 

up a bit, left a bit.....
We drove to 3 other sights and I am sad to report only saw only one other patient, a little girl of 5 who seemed terrified of all the attention and whose non-albino brother had appropriated her hat and sunglasses.  Good to see that brothers are the same the world over!  I was pleased to hear that most of the outreach clinics are much busier and hopefully the patients that missed their appointments will come to the RDTC for screening if they are worried.  Sadly people often present far too late and only last week we saw a young man with a huge basal cell carcinoma above his eye and extending into his eye.  We offered him surgery and although it would have been curative he would have lost his eye.  He declined not because of this but because of his belief that the tumour would spread all over his body if it was operated on.  Sebastian, a fantastic final year dermato-surgical Registrar from Germany, has been doing great work operating and doing flap and graft repairs on many of the albino patients.  Unfortunately for reasons unknown albino patients have a very high incidence of post-surgical cutaneous infection and if any of you know why I would be grateful if you could send me a comment.

Working presently at the RDTC is a brilliant, warm and funny Spanish  pharmacist called Mafalda who reminds me of a cross between Amy Winehouse (who she dressed up as at a Halloween party and Penelope Cruz in Vicky Cristina Barcelona).  She has a masters in Tropical Medicine and was working with albinos in Malawi before coming to Tanzania.  She is employed by a Spanish NGO on an excellent project and is raising money for a small building in the RDTC grounds where suncream can be manufactured by local people using local ingredients.  Last week there were queues of albino patients at the RDTC who had been given 3 different suncreams to try for 24 hours and then they came back to fill in a questionnaire about their preferences.  Interestingly the patients’ preference was the least expected one as it caused the most whitening of the skin.  It is always fascinating how ones preconceived ideas are
 often wrong!

how much for all the tomatoes?
I took advantage of the long hours in the bus to take Swahili lessons from Alice a Resident from Rwanda.  I have promised to teach her paediatric dermatology in return.  I had a chance to practice my new skills when we stopped at a great fruit and vegetable market on the way home.  I was very proud when I could ask the price of cucumbers “Ni bei gani tango?” but unfortunately couldn’t understand the answer!  I can also say “that’s too expensive, reduce the price as I work here” although the dramatic effect is lessened by reading it off a scrappy piece of paper!  It was interesting to see that you pay about half the price of a pineapple if you are shopping with a local….

Rebecca helping to carry the shopping home!

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